1
|
Zhang J, Song L, Ma Z, Sun L, Wang X, Liu D, Huang F, Man Y. Intra-abdominal pressure and residual renal function decline in peritoneal dialysis: a threshold-based investigation. Ren Fail 2024; 46:2312535. [PMID: 38321869 PMCID: PMC10851793 DOI: 10.1080/0886022x.2024.2312535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The potential impact of elevated intra-abdominal pressure (IAP) on residual renal function (RRF) has not been determined. The objective of this study was to investigate the relationship between IAP and the rate of RRF decline in newly initiated peritoneal dialysis (PD) patients, and to identify the optimal IAP threshold value for delaying the deterioration of RRF. METHODS A cohort of 62 newly initiated PD patients who completed both 6- and 12-month follow-up evaluations was obtained using the Durand method. A logistic regression model was used to identify variables associated with a rapid decline in RRF. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold value. Another retrospective cohort analysis was performed to validate the identified critical value. RESULTS For each 1 cmH2O increase in IAP, the risk of a rapid decline in the RRF increased by a factor of 1.679. Subsequent analysis revealed that patients in the high IAP group had more significant decreases in residual renal estimated glomerular filtration rate (eGFR) (Z = -3.694, p < 0.001) and urine volume (Z = -3.121, p < 0.001) than did those in the non-high IAP group. Furthermore, an IAP ≥15.65 cmH2O was a robust discriminator for the prediction of the rate of RRF decline. CONCLUSION Patients in the high IAP group experienced a more rapid decline in RRF. Additionally, an optimal critical pressure of 15.65 cmH2O was identified for predicting the rate of RRF decline. IAP, as one of the factors contributing to the rapid decline in RRF in the first year of PD, should be given due attention.
Collapse
Affiliation(s)
- Jingjing Zhang
- Graduate School of Jinzhou Medical University, Jinzhou, PR China
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Lei Song
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Zhongwei Ma
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Lina Sun
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Xiaoqing Wang
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Duanyan Liu
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Feng Huang
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Yulin Man
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| |
Collapse
|
2
|
Chen YW, Liao CT, Wu MY, Huang NJ, Cherng YG, Wu MS, Hsu YH, Chen CH. Pressure induces peritoneal fibrosis and inflammation through CD44 signaling. Ren Fail 2024; 46:2384586. [PMID: 39082695 PMCID: PMC11293264 DOI: 10.1080/0886022x.2024.2384586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 08/03/2024] Open
Abstract
Peritoneal dialysis (PD) is a widely used sustainable kidney replacement therapy. Prolonged use of PD fluids is associated with mesothelial-mesenchymal transition, peritoneal fibrosis, and eventual ultrafiltration (UF) failure. However, the impact of pressure on the peritoneum remains unclear. In the present study, we hypothesized increased pressure is a potential contributing factor to peritoneal fibrosis and investigated the possible mechanisms. In vitro experiments found that pressurization led to a mesenchymal phenotype, the expression of fibrotic markers and inflammatory factors in human mesothelial MeT-5A cells. Pressure also increased cell proliferation and augmented cell migration potential in MeT-5A cells. The mouse PD model and human peritoneum equilibrium test (PET) data both showed a positive association between higher pressure and increased small solute transport, along with decreased net UF. Mechanistically, we found that significant upregulation of CD44 in mesothelial cells upon pressurization. Notably, the treatment of CD44 neutralizing antibodies prevented pressure-induced phenotypic changes in mesothelial cells, while a CD44 inhibitor oligo-fucoidan ameliorated pressure-induced peritoneal thickening, fibrosis, and inflammation in PD mice. To conclude, intraperitoneal pressure results in peritoneal fibrosis in PD via CD44-mediated mesothelial changes and inflammation. CD44 blockage can be utilized as a novel preventive approach for PD-related peritoneal fibrosis and UF failure.
Collapse
Affiliation(s)
- Yu-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Chia-Te Liao
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Nai-Jen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mai-Szu Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yung-Ho Hsu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Cheng-Hsien Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
3
|
Chen Y, Zhang M, Li Y, Xie Q, Dai S, Ge X, Hao CM, Zhu T. Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors. J Nephrol 2024:10.1007/s40620-024-02009-3. [PMID: 38997573 DOI: 10.1007/s40620-024-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. METHODS This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. RESULTS The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. CONCLUSIONS Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.
Collapse
Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yuan Li
- Division of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| |
Collapse
|
4
|
Ma T, Li X, Hao J, Song D, Wang H, Liu T, Zhang Y, Abi N, Xu X, Dong J. The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications in peritoneal dialysis patients. J Nephrol 2024:10.1007/s40620-024-01913-y. [PMID: 38512377 DOI: 10.1007/s40620-024-01913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Increased intraperitoneal pressure is associated with abdominal wall complications and technical failure of peritoneal dialysis (PD). Several equations have been developed to estimate intraperitoneal pressure. We aimed to assess the prognostic yield of the intraperitoneal pressure as estimated by current equations on the occurrence of abdominal wall complications in peritoneal dialysis patients. METHODS This is a retrospective analysis of data from a prospective cohort which recruited 1207 incident PD patients. Estimated intraperitoneal pressure was calculated using four available equations (according to Sigogne, Castellanos, Scanziani and de Jesus Ventura). Abdominal wall complications were recorded during follow-up. Univariate analysis and multivariate analysis with competing risk regression were used to assess the predictive power of the estimates of intraperitoneal pressure in the occurrence of abdominal wall complications. RESULTS During a median follow-up of 30 months, 66 (5.5%) patients (1.6/100 patient-years) developed abdominal wall complications. The median time to the occurrence of abdominal wall complications was 5.7 months. Only the estimated intraperitoneal pressure by the de Jesus Ventura equation significantly predicted abdominal wall complications by using univariate analyses. Associations between estimated intraperitoneal pressure by the de Jesus Ventura equation and the occurrence of abdominal wall complications disappeared after adjusting for significant clinical factors. CONCLUSIONS We verified the prognostic value of estimation of intraperitoneal pressure by four available equations in predicting abdominal wall complications in our single-center PD cohort. Due to a low diagnostic yield, a novel equation for estimating the intraperitoneal pressure is urgently needed.
Collapse
Affiliation(s)
- Tiantian Ma
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Xinqiu Li
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Jiayu Hao
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Di Song
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Hongyan Wang
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Tianjiao Liu
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Yaling Zhang
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Nanzha Abi
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Xiao Xu
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Jie Dong
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China.
| |
Collapse
|
5
|
Betancourt L, Pico S, Rojas E, Gordo MJ, Oliva JC, Almirall J, Ponz E. Relationship between intraperitoneal pressure and the development of hernias in peritoneal dialysis: confirmation for the first time of a widely accepted concept. Int Urol Nephrol 2024; 56:759-765. [PMID: 37566322 DOI: 10.1007/s11255-023-03663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Intraperitoneal pressure (IPP) in peritoneal dialysis (PD) is an individual characteristic that can be modified by posture and intraperitoneal volume (IPV). It is considered one of the predisposing factors for complications in the abdominal wall, such as the appearance of hernias. No studies to date have confirmed this. The main aim of this study was to assess the relationship between the development of hernia in incident PD patients and IPP measured at PD onset. METHODS A prospective observational study of incident patients in a PD programme between 2010 and 2020. IPP was measured using the Durand's method. RESULTS One hundred and twenty-four incident patients on PD, 68% male, mean age 62.1 ± 15.23 years, body mass index (BMI) 27.7 ± 4.82 kg/m2, 44% were diabetic. IPP in supine was 16.6 ± 4.60 cm H2O for a mean IPV of 2047.1 ± 359.19 mL. Hernias were reported in 18.5% of patients during PD follow-up: 57% were inguinal hernias, 33% umbilical, and a further 10% presented in a combined form. PD hernias correlated positively with IPP in supine position (p = 0.037), patient age (p = 0.008), BMI (p = 0.043), a history of prior hernia (0.016), laparoscopic catheter placement (p = 0.026), and technique failure (p = 0.012). In the multivariate analysis, a higher IPP was independently related to the development of hernias (p = 0.028). CONCLUSIONS The development of hernias in PD was related to a higher IPP at PD onset, older age, higher BMI, history of prior hernia, catheter placement by laparoscopy, and technique failure.
Collapse
Affiliation(s)
- Loreley Betancourt
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain.
- Department of Medicine UAB, Barcelona, Spain.
| | - Sandy Pico
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Estefania Rojas
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Maria Jose Gordo
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Juan Carlos Oliva
- Department of Medicine UAB, Statistics Unit, Parc Tauli Sabadell, University Hospital, Barcelona, Spain
| | - Jaume Almirall
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| | - Esther Ponz
- Department of Nephrology, Parc Tauli Sabadell, University Hospital, Parc Tauli 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine UAB, Barcelona, Spain
| |
Collapse
|
6
|
Agarwal S, Gillis L, Wilkie M. Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease. Clin J Am Soc Nephrol 2024:01277230-990000000-00331. [PMID: 38190135 DOI: 10.2215/cjn.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article-diabetes mellitus, polycystic kidney disease, and chronic liver disease. Each of these conditions requires an understanding of both its effect on the delivery of the PD and the effect of the PD on the condition itself. In diabetes, glucose absorption from the dialysate complicates metabolic control and affects salt and water management and patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to polycystic kidney disease, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution, and therefore, the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease, key issues include nutritional support because PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites and reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high-however, PD may present a better management option than hemodialysis in many patients-particularly in those where the liver disease is complicated by low BP, clotting abnormalities, or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high-quality information in which risks, benefits, and management strategies are clearly presented.
Collapse
Affiliation(s)
- Shailesh Agarwal
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | |
Collapse
|
7
|
Jang H, Lee N, Jeong E, Park Y, Jo Y, Kim J, Kim D. Abdominal compartment syndrome in critically ill patients. Acute Crit Care 2023; 38:399-408. [PMID: 38052507 DOI: 10.4266/acc.2023.01263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.
Collapse
Affiliation(s)
- Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dowan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
8
|
Ferreira AC. Intraperitoneal pressure in peritoneal dialysis patients: a need for treatment individualization. Clin Kidney J 2023; 16:1367-1368. [PMID: 37664561 PMCID: PMC10469088 DOI: 10.1093/ckj/sfad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 09/05/2023] Open
Abstract
High-quality and goal-directed peritoneal dialysis (PD) prescription should be provided to all PD patients. Prioritizing patients' goals is necessary for their quality of life, as it is assessment of volume and nutritional status, anemia and mineral and bone management, or small-solute removal. To optimize the removal of small solutes, and depending on membrane characteristics, the increase in concentration gradient difference or the increase in volume (recruitment of all peritoneal capacities) can be performed. Nevertheless, intraperitoneal volume should be tailored by measuring the intraperitoneal pressure (IPP) to avoid PD associated mechanical complications. In this editorial, a brief review on how IPP can be measured, and its implications are noted.
Collapse
Affiliation(s)
- Ana Carina Ferreira
- Nephrology Department – Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| |
Collapse
|
9
|
Li X, Ma T, Hao J, Song D, Wang H, Liu T, Zhang Y, Abi N, Xu X, Zhang M, Sun W, Li X, Dong J. Novel equations for estimating intraperitoneal pressure among peritoneal dialysis patients. Clin Kidney J 2023; 16:1447-1456. [PMID: 37664572 PMCID: PMC10469109 DOI: 10.1093/ckj/sfad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Indexed: 09/05/2023] Open
Abstract
Background Increased intraperitoneal pressure (IPP) is associated with abdominal wall complications and technical failure in peritoneal dialysis (PD). Since the standard measurement of IPP is limited due to its cumbersome procedures, we aimed to develop and validate equations for estimating IPP. Methods We performed a cross-sectional study with a total of 200 prevalent PD patients who were divided into development and validation datasets after random sampling matched by body mass index. The IPPs were measured using the Durand method, with whole-body and abdominal anthropometry indices collected. Equations with 2.0-L and 1.5-L fill volumes were generated by stepwise linear regression modelling. The bias, accuracy and precision of the estimated IPP (eIPP) with 2-L and 1.5-L fill volumes were compared with actual IPPs by the Durand method. The eIPP for the 2-L fill volume was also compared with other existing equations. Results Two new equations incorporating waist circumference and height from the decubitus plane to mid-axillary line were generated. The eIPPs exhibited small biases in relation to the Durand method , with median differences of -0.24 cmH2O and -0.10 cmH2O for 2 L and 1.5 L, respectively. The precisions evaluated by the standard deviation of the absolute value of the differences were 2.59 cmH2O and 2.50 cmH2O, respectively. The accuracies evaluated by the value of the percentage of estimates that differed by >20% for the eIPP were 26% for 2.0 L and 27% for 1.5 L. Better bias, precision and accuracy were observed for the eIPP equation compared with other existing equations for the 2.0-L fill volume. Conclusions We provided two new equations developed from abdominal anthropometry indices to accurately estimate the IPP in the PD population.
Collapse
Affiliation(s)
- Xinqiu Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jiayu Hao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Di Song
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hongyan Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Tianjiao Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yaling Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Nanzha Abi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Manze Zhang
- School of Basic Medical Sciences Peking University, China
| | - Weiqi Sun
- School of Basic Medical Sciences Peking University, China
| | - Xin Li
- School of Basic Medical Sciences Peking University, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| |
Collapse
|
10
|
Oviedo Flores K, Kaltenegger L, Eibensteiner F, Unterwurzacher M, Kratochwill K, Aufricht C, König F, Vychytil A. Assessing mechanical catheter dysfunction in automated tidal peritoneal dialysis using cycler software: a case control, proof-of-concept study. Sci Rep 2022; 12:5657. [PMID: 35383211 PMCID: PMC8983779 DOI: 10.1038/s41598-022-09462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
New recommendations on evaluation of peritoneal membrane function suggest ruling out catheter dysfunction when evaluating patients with low ultrafiltration capacity. We introduce the use of a combination of parameters obtained from the cycler software PD Link with HomeChoicePro (Baxter International Inc., Illinois, United States) cyclers for predicting catheter dysfunction in automated peritoneal dialysis patients (APD). Out of 117 patients treated at the Medical University of Vienna between 2015 and 2021, we retrospectively identified all patients with verified catheter dysfunction (n = 14) and compared them to controls without clinical evidence of mechanical catheter problems and a recent X-ray confirming PD catheter tip in the rectovesical/rectouterine space (n = 19). All patients had a coiled single-cuff PD catheter, performed tidal PD, and received neutral pH bicarbonate/lactate-buffered PD fluids with low-glucose degradation products on APD. Icodextrin-containing PD fluids were used for daytime dwells. We retrieved cycler data for seven days each and tested parameters' predictive capability of catheter dysfunction. Total number of alarms/week > 7 as single predictive parameter of catheter dislocation identified 85.7% (sensitivity) of patients with dislocated catheter, whereas 31.6% (1-specificity) of control patients were false positive. A combination of parameters (number of alarms/week > 7, total drain time > 22 min, ultrafiltration of last fill < 150 mL) where at least two of three parameters appeared identified the same proportion of patients with catheter dislocation, but was more accurate in identifying controls (21.1% false positive). In contrast to yearly PET measurements, an easily applicable combination of daily cycler readout parameters, also available in new APD systems connected to remote monitoring platforms shows potential for diagnosis of catheter dysfunction during routine follow-up.
Collapse
Affiliation(s)
- Krystell Oviedo Flores
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Baxter Healthcare GmbH, Vienna, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Medical University of Vienna, Vienna, Austria
| | - Markus Unterwurzacher
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Medical University of Vienna, Vienna, Austria
| | - Klaus Kratochwill
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Franz König
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
11
|
Duquennoy S, Leduc V, Podevin E. Imaging and leaks in peritoneal dialysis. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysate leaks are non-rare mechanical but dreaded complications in peritoneal dialysis (PD). They usually occur at the beginning of PD, with various clinical events depending on their location. Use of imaging tests such as computed tomography (CT) peritoneography, or magnetic resonance imaging (MRI) peritoneography, or scintigraphic peritoneography, can confirm the diagnosis and guide surgical intervention if needed. These simple, non-invasive, and accessible tests can be done in collaboration between the radiological et peritoneal teams. Depending on the leakage site, PD can be pursued with small volumes with a cycler. In other cases, it must be interrupted and the patient transferred to hemodialysis, in order to permit the peritoneal cavity to regain its integrity by cicatrization or with surgical intervention. Imaging can help to make sure peritoneal cavity has regained its integrity after this period of transition. Early leaks can be avoided by delaying PD start with by 14 days. Intraperitoneal pressure does not seem to contribute significantly. Prevention of PD leaks essentially depends on individual risk factors such as obesity or anterior abdominal surgeries. This article reviews the characteristics of dialysate leaks in PD and the imagery tests to limit transfer to hemodialysis.
Collapse
|
12
|
Sobrino-Pérez A, Pérez-Escudero A, Fernández-Arroyo L, Dorado-García A, Martín-Alcón B, Gutiérrez-Martín C, Sánchez-Fonseca C, Barrios-Rebollo C, Pérez-Díaz V. Intraperitoneal pressure: Stability over time and validation of Durand's measurement method. Perit Dial Int 2020; 41:427-431. [PMID: 33250004 DOI: 10.1177/0896860820973120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intraperitoneal pressure (IPP) is gaining consideration as a relevant parameter of peritoneal dialysis (PD) in adults, although many of its aspects are still pending clarification. We address here its stability over time and the validity of the usual method of clinical measurement, as proposed by Durand in 1992 but never specifically validated. We performed this validation by comparing Durand's method and direct measurements with a central venous pressure system. We performed a total of 250 measurement pairs in 50 patients with different intraperitoneal volumes plus in-vitro measurements with a simulated peritoneum. Absolute differences between the two systems in vivo were 0.87 ± 0.91 cmH2O (range 0-5 cmH2O); only 6.4% of them were ≥3 cmH2O. In vitro results for both methods were identical. We also compared IPP measurements in the same patient separated by 1-4 h (514 measurement pairs in 136 patients), 1 week (92 pairs in 92 patients), and 2 years (34 pairs in 17 patients). Net differences of measurements separated by hours or 1 week were close to 0 cmH2O, with oscillations of 1.5 cmH2O in hours and 2.3 cmH2O in 1 week. IPP measured 2 years apart presented a net decrease of 2.5 ± 4.9 cmH2O, without correlation with body mass index changes or any other usual parameter of PD. In hours, 7% of IPP differences were >3 cmH2O, 22% in 1 week, and 50% in 2 years. In conclusion, Durand's method is precise enough to measure IPP in peritoneal dialysis. This parameter is not stable over long timescales, so it is necessary to use recent measurements.
Collapse
Affiliation(s)
- Alicia Sobrino-Pérez
- Servicio de Nefrología, 16238Hospital Clínico Universitario de Valladolid, Spain
| | - Alfonso Pérez-Escudero
- Research Center on Animal Cognition (CRCA), Center for Integrative Biology (CBI), Toulouse University, CNRS, UPS, Toulouse, France
| | | | - Ana Dorado-García
- Servicio de Nefrología, 16918Hospital Universitario Rio Hortega de Valladolid, Spain
| | - Berta Martín-Alcón
- Servicio de Nefrología, 70701Complejo Asistencial Universitario de Palencia, Spain
| | | | | | | | - Vicente Pérez-Díaz
- Servicio de Nefrología, 16238Hospital Clínico Universitario de Valladolid, Spain.,Departmento de Medicina, Dermatología y Toxicología, Universidad de Valladolid, Spain
| | | |
Collapse
|
13
|
Chionh CY, Finkelstein FO, Ronco C. Peritoneal dialysis for acute kidney injury: Equations for dosing in pandemics, disasters, and beyond. Perit Dial Int 2020; 41:307-312. [PMID: 33174468 DOI: 10.1177/0896860820970066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a viable option for renal replacement therapy in acute kidney injury (AKI), especially in challenging times during disasters and pandemics when resources are limited. While PD techniques are well described, there is uncertainty about how to determine the amount of PD to be prescribed toward a target dose. The aim of this study is to derive practical equations to assist with the prescription of PD for AKI. METHODS Using established physiological principles behind PD clearance and membrane transport, a primary determinant of dose delivery, equations were mathematically derived to estimate dialysate volume required to achieve a target dose of PD. RESULTS The main derivative equation is VD = (1.2 × std-Kt/V × TBW)/(tdwell + 4), where VD is the total dialysate volume per day, std-Kt/V is the desired weekly dose, TBW is the total body water, and tdwell is the dwell time. VD can be expressed in terms of dwell volume, vdwell, by VD = (0.3 × std-Kt/V × TBW) - (6 × vdwell). Two further equations were derived which directly describe the mathematical relationship between tdwell and vdwell. A calculator is included as an Online Supplementary Material. CONCLUSIONS The equations are intended as a practical tool to estimate solute clearances and guide prescription of continuous PD. The estimated dialysate volume required for any dose target can be calculated from cycle duration or dwell volume. However, the exact target dose of PD is uncertain and should be adjusted according to the clinical circumstances and response to treatment. The equations presented in this article facilitate the adjustment of PD prescription toward the targeted solute clearance.
Collapse
Affiliation(s)
- Chang Yin Chionh
- Department of Renal Medicine, 26674Changi General Hospital, Singapore
| | | | - Claudio Ronco
- Department of Medicine, 9308Università degli Studi di Padova, Padua, Italy.,Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza, Vicenza, Italy
| |
Collapse
|
14
|
Sigogne M, Kanagaratnam L, Mora C, Pierre M, Petrache A, Marcus C, Fischbach M, Dramé M, Touré F. Identification of the Factors Associated With Intraperitoneal Pressure in ADPKD Patients Treated With Peritoneal Dialysis. Kidney Int Rep 2020; 5:1007-1013. [PMID: 32647758 PMCID: PMC7335974 DOI: 10.1016/j.ekir.2020.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Peritoneal dialysis (PD) is reported to be underused in the autosomal dominant polycystic kidney disease (ADPKD) population because doctors fear technical failure caused by reduced abdominal space and high intraperitoneal pressure (IPP). Methods We designed a multicenter retrospective study to be carried out in 15 French centers recruiting 60 patients with ADPKD treated with PD to identify factors associated with IPP. Inclusion criteria were start of PD between 2010 and 2017, available tomodensitometry, and IPP measurement in the first year of dialysis. The clinical and radiological data for each patient were reviewed by the same operator. Total kidney volume (TKV), liver volume, and the volume of the abdominal cavity were measured using contouring. Results TKV and the volume of the abdominal cavity in women and men were, respectively, 2397 ml versus 3758 ml and 9402 ml versus 12,920 ml. In the univariate analysis, IPP was significantly and positively associated with body surface area (P = 0.0024), body mass index (BMI) (P < 0.0001), the volume of the abdominal cavity (P = 0.0005), and the volume of the dialysate infused in the peritoneal cavity (IPV) (P = 0.0108). In the multivariate analysis, only BMI was still significantly associated with IPP (P = 0.0004) Conclusions Our results identified BMI as the main factor linked to IPP in patients with ADPKD. Despite a reliable assessment of the volume of their organs we did not find any correlation between liver and kidney volumes and IPP. To our knowledge, this is the first study designed to identify factors associated with IPP in patients with ADPKD on PD.
Collapse
Affiliation(s)
- Mickael Sigogne
- Division of Nephrology, University Hospital of Reims, Reims, France.,Division of Nephrology, University Hospital of Angers, Angers, France.,Division of Nephrology, Hospital of Le Mans, Le Mans, France
| | | | - Caroline Mora
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Malika Pierre
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Andreea Petrache
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Claude Marcus
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Michel Fischbach
- Division of Nephrology, University Hospital of Strasbourg, Strasbourg, France
| | - Moustapha Dramé
- Division of Nephrology, University Hospital of Angers, Angers, France
| | - Fatouma Touré
- Division of Nephrology, University Hospital of Reims, Reims, France.,Nephrology Laboratory, Unit 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims Champagne Ardenne University, Reims, France
| |
Collapse
|
15
|
Schneditz D, Sauseng N, Pütün E, Rosenkranz AR, Ribitsch W. Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure. Perit Dial Int 2020; 40:477-486. [PMID: 32063186 DOI: 10.1177/0896860819895176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Increased intra-abdominal pressure (PIA) leads to venous congestion in splanchnic and adjoining circulations. The aim is to examine whether PIA in peritoneal dialysis (PD) affects the mobilization of extracellular fluid from the lower body in supine body position. METHODS Patients were studied during a regular peritoneal equilibration test (PET) in supine body position using multifrequency bioimpedance analysis to determine extracellular resistance and absolute volume overload (AVO) in wrist-to-ankle (W2A) as well as in ankle-to-ankle (A2A) configurations. Measurements were taken at baseline (T0) after draining the peritoneal cavity, at T1 shortly after filling with 2 L of standard dialysate, and at T2 before taking the 2 h PET samples. PIA was measured from the column height in the PD catheter. Extracellular resistance in the lower extremities (RL) was taken as half of the A2A resistance. RESULTS Eighteen patients (56 ± 15 years, 76 ± 21 kg, body mass index (BMI) 26.4 ± 7 kg/m2, 13 men) were studied. After having assumed a supine body position for the duration of 17, 77, and 155 min, AVO continuously decreased from 1.6 ± 1.3 (T0) to 1.2 ± 1.5 (T1) and 1.0 ± 1.4 L (T2). RL significantly increased from 238 ± 57 (T0) to 254 ± 62 (T1) and 264 ± 67 Ohm (T2). This increase was negatively correlated to BMI and PIA measured at any time point, but not to net ultrafiltration volume. CONCLUSIONS Orthostatic fluid shifts from the lower limbs may take up to 2 h in supine PD patients, especially with high BMI and PIA because of venous congestion in splanchnic and adjoining circulations.
Collapse
Affiliation(s)
- Daniel Schneditz
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Notburga Sauseng
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Ezgi Pütün
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| |
Collapse
|
16
|
Pérez-Díaz V, Pérez-Escudero A, Sanz-Ballesteros S, Sánchez-García L, Hernández-García E, Oviedo-Gómez V, Sobrino-Pérez A. Clinical relevance of marginal factors on ultrafiltration in peritoneal dialysis. Perit Dial Int 2020; 41:86-95. [PMID: 32048915 DOI: 10.1177/0896860820904556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ultrafiltration (UF) in peritoneal dialysis (PD) is mainly driven by the osmotic gradient and peritoneal permeability, but other factors-such as intraperitoneal pressure (IPP)-also have an influence. METHODS To assess the clinical relevance of these marginal factors, we studied 41 unselected PD patients undergoing two consecutive 2 h, 2.27% glucose exchanges, first with 2.5 L and then with 1.5 L. RESULTS IPP, higher in the 2.5 L exchange, had a wide interpatient range, was higher in obese and polycystic patients and their increase with infusion volume was higher for women regardless of body size. UF with 2.5 L correlated inversely with IPP and was higher for patients with polycystosis or hernias, while for 1.5 L we found no significant correlations. The effluent had higher glucose and osmolarity in the 2.5 L exchange than in the 1.5 L one, similar for both sexes. In spite of this stronger osmotic gradient, only 21 patients had more UF in the 2.5 L exchange, with differences up to 240 mL. The other 20 patients had more UF in the 1.5 L exchange, with stronger differences (up to 800 mL, and more than 240 mL for 9 patients). The second group, with similar effluent osmolarity and peritoneal equilibration test (PET) parameters than the first, has higher IPP and preponderance of men. The sex influence is so intense that men decreased average UF with 2.5 L with respect to 1.5 L, while women increased it. CONCLUSIONS With 2.27% glucose, sex and IPP-modulated by obesity, polycystosis, hernias, and intraperitoneal volume-significantly affect UF in clinical settings and might be useful for its management.
Collapse
Affiliation(s)
- Vicente Pérez-Díaz
- Servicio de Nefrología, 16238Hospital Clínico Universitario de Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology, Universidad de Valladolid, Spain
| | - Alfonso Pérez-Escudero
- Research Center on Animal Cognition (CRCA), Center for Integrative Biology (CBI), Toulouse University, CNRS, UPS, France
| | - Sandra Sanz-Ballesteros
- Servicio de Nefrología, 16238Hospital Clínico Universitario de Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology, Universidad de Valladolid, Spain
| | - Luisa Sánchez-García
- Servicio de Nefrología, 16918Hospital Universitario Rio Hortega de Valladolid, Spain
| | | | | | - Alicia Sobrino-Pérez
- Servicio de Nefrología, 16238Hospital Clínico Universitario de Valladolid, Spain
| |
Collapse
|
17
|
Thangarasa T, Foisy D, Leidecker J, Corsi DJ, Meggison H, Blew B, Warren J, Zimmerman D. In Search of a Simple and Reliable Method of Measuring Intra-abdominal Pressure in Peritoneal Dialysis Patients. Can J Kidney Health Dis 2019; 6:2054358119892695. [PMID: 31839976 PMCID: PMC6900622 DOI: 10.1177/2054358119892695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Patients treated with peritoneal dialysis (PD) are at increased risk of
developing mechanical complications such as dialysate leaks and hernias
thought to be partially related to an increase in intra-abdominal pressure
(IAP) secondary to dialysate in the abdomen. However, measurement of IAP
requires specialized equipment that is not readily available in the home
dialysis unit. Objectives: To develop a reliable method of measuring IAP in PD patients that could be
easily used in the home dialysis unit. We hypothesized that the handheld
Stryker pressure monitor would be suitable for this purpose via connection
to the PD catheter. Design: Cross-sectional. Setting: Tertiary Care Hospital, Ottawa, Ontario, Canada. Patients: Patients who were having a PD catheter inserted via laparoscopic surgery at
The Ottawa Hospital were recruited for the study. Measurements: With the patients at end-expiration, the IAP measured with the Stryker
monitor connected to the PD catheter was compared with the insufflator
pressures of 15, 10, and 5 mm Hg. Methods: Bland-Altman plots were constructed and intraclass correlation coefficients
were calculated for each pressure. Results: Twelve patients participated in the study: 9 men and 3 women. They were on
average 53 ± 15 years old and 81 ± 13.4 kg. Two patients had to be excluded
from the analysis due to difficulties zeroing the Stryker pressure monitor
at the time of surgery. There were also rapid fluctuations in the
insufflator pressure recording, creating additional challenges in comparing
the 2 measurements at end-expiration. The 95% limits of agreement for the
Bland-Altman plots ranged from 7.9 (@15 mm Hg) to 12.2 (@10 mm Hg). The
intraclass correlation coefficients for reliability of the individual
measurements ranged from 0.015 (10 mm Hg) to 0.634 (15 mm Hg). Limitations: Small sample size and lack of a gold standard comparator may have affected
our results. Conclusions: In our study, we used the operating room insufflator as the gold standard for
measuring IAP. By Bland-Altman plots and intraclass correlation
coefficients, the pressure values obtained with the Stryker pressure monitor
were not a reliable estimate of insufflator IAP especially at lower
pressures. Further studies are needed to identify an ideal tool for
measurement of IAP to guide PD management.
Collapse
Affiliation(s)
| | - Dana Foisy
- Division of Nephrology, Department of Medicine, Ottawa Hospital, ON, Canada
| | - Julie Leidecker
- Kidney Research Center, The Ottawa Hospital Research Institute, ON, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada
| | - Hilary Meggison
- Division of Intensive Care, Department of Medicine, Ottawa Hospital, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, Ottawa Hospital, Ottawa, ON, Canada
| | - Jeffery Warren
- Division of Urology, Department of Surgery, Ottawa Hospital, Ottawa, ON, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, Ottawa Hospital, ON, Canada.,Kidney Research Center, The Ottawa Hospital Research Institute, ON, Canada
| |
Collapse
|
18
|
Verger C, Chanliau J. History of peritoneal dialysis in France. BULLETIN DE LA DIALYSE À DOMICILE 2019. [DOI: 10.25796/bdd.v2i3.22103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In France the first peritoneal dialysis was performed in the mid-1940s. For a long time reserved for frail subjects in whom hemodialysis appeared more dangerous, it is considered nowadays as a technique equivalent to hemodialysis, provided its indications and contraindications are respected and associated with the respect of the patient’s free choice after objective information. In particular, there is now a consensus to recognize its interest in patients waiting for transplantation, usually in order to preserve vascular access. Over the past decades French teams have played their role nationally and internationally, very often in partnership with their European neighbors, to improve the results achieved and to improve the different modalities. Since the end of the 1980s, the evaluation of practices has been made possible thanks to the participation in a specialized peritoneal dialysis registry.This article is a general review, not exhaustive, of the role played by the main French teams who succeeded one another.
Collapse
|